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Skills

  • High-level knowledge of revenue cycle management
  • Negotiating settlements for past-due claims
  • Training and onboarding of billing and collections staff
  • Managing high-volume claims with attention to detail and precision
  • Strong organizational skills for managing multiple claims simultaneously
  • Customer service excellence when interacting with patients and insurance representatives
  • Consistently achieving or exceeding monthly collection goals
  • Collaborating with legal teams for complex workers' compensation cases
  • Monthly reporting on collections and financial performance
  • Cost-saving strategies by minimizing the risk of claim denials

Work Experiences

  • Collaborated with insurance providers to expedite approvals and authorizations, shortening claim processing times by 65%.
  • Developed monthly financial reports to track workers' comp bill collections, identifying opportunities for improvement.
  • Collaborated with attorneys and regulatory agencies on complex claim disputes, significantly reducing legal escalations.
  • Achieved an average approval rate of 80%.
  • Corresponded with insurers regularly to ensure timely reimbursement, securing $9 in outstanding payments.
  • Achieved a 27% improvement in payment timeliness.
  • Achieved recovery in under three years.
  • Collaborated cross-functionally to resolve disputes.
  • Aligned with workers' comp requirements.
  • Coordinated with insurance companies.

Summaries

  • Accomplished in resolving complex claim issues, frequently liaising with insurers to recover 53% of denied or unresolved claims in under several months.
  • Consistently identify areas for improvement.
  • Adhered to all HIPAA regulations.
  • Collaborative team leader.
  • Adjusted communications with adjusters.
  • Achieved recovery in three years.
  • Detail-oriented Workers Compensation Biller Collector known for processing an average of 6 claims per month with a 53% success rate in handling denials and appeals, reducing outstanding balances by $6.
  • Cut claim submission time by 39%.
  • Achieved recovery in under one year.
  • Achieved results within 2 weeks.

Accomplishments

  • Successfully collaborated with adjusters and attorneys to resolve disputed claims, settling 33% of cases out of court, reducing legal expenses.
  • Negotiated settlements for past-due claims, successfully recovering over $155,000 in outstanding fees across one year.
  • Led cross-functional efforts with finance and legal departments to ensure full regulatory compliance, preventing potential fines and reducing audits by 4.
  • Successfully reduced claim rejections by 51% by employing detailed audits and process improvements.
  • Enhanced pre-authorization compliance efforts resulting in fewer disputes and denials, improving first-pass approval rates by 53% during 2019.
  • Developed a comprehensive training program to educate team members on efficient claim submission processes, reducing claim rejections by 20%.
  • Developed and implemented an automated claims follow-up system, reducing manual workloads and elevating claims processing speed by 34%.
  • Created and presented monthly financial reports for management, identifying key areas for optimization that improved collection rates by 39%.
  • Contributed to reduction of organizational days-sales-outstanding (DSO) metric by 8 days through timely follow-up and engagement with payers.
  • Developed strong partnerships with caseworkers and adjusters to expedite claim reviews and shorten approval cycles by 11 days.

Affiliations

  • Member, National Healthcare Collectors Association (NHCA), with continuing education in collections and accounts receivable.
  • Attended National Conference on Medical Billing and Coding 2015, with focus on optimizing collections for workers' comp claims.
  • Board Member, Workers’ Compensation Research Institute (WCRI) – Contributor to discussions on policy and process improvements.
  • Completed certification in Billing and Coding through process, with concentration in workers’ compensation procedures.
  • Certified Workers' Compensation Specialist (CWCS) through CWCS programs, trained in managing complex billing situations.
  • Completed Workers' Compensation Claims Management Training through procedure, focusing on claim disputes.
  • Pursued Advanced Billing Compliance Certification from framework specializing in workers' compensation billing compliance.
  • Participated in the Workers' Compensation Medicare Set-Aside (WCMSA) Training, ensuring compliance and reducing legal risks.
  • Certified Revenue Cycle Specialist (CRCS) from the American Association of Healthcare Administrative Management (AAHAM).
  • Member, Workers' Compensation Insurance Organizations (WCIO), developing knowledge on industry trends and claims processing.

Certifications

  • Certified Claims Professional (CCP), Workers' Compensation Specialization
  • Healthcare Financial Management Association (HFMA) Certified Revenue Cycle Representative
  • Advanced Workers' Compensation Settlements and Negotiations
  • Certified Professional Biller (CPB) by AAPC
  • Certified Revenue Integrity Professional (CRIP)
  • Medical Billing and Coding Certification in Workers' Comp (CPT/ICD-10)
  • Accreditation in Medical Billing, Specializing in Workers Compensation
  • Comprehensive Workers' Compensation Claims Certification
  • Certified Revenue Cycle Specialist (CRCS)
  • Healthcare Collections Management Certification by Northwind

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